System and method of harvesting osteochondral plugs

ABSTRACT

A method is disclosed and can include engaging a harvest guide with bony tissue and placing a cutting device within the harvest guide. The harvest guide can maintain the cutting device substantially perpendicular to a tangent through a point on the bony tissue aligned with the cutting device. The cutting device can be an osteochondral chisel, a trephine, or a combination thereof.

FIELD OF THE DISCLOSURE

The present disclosure relates generally to orthopedics and orthopedicsurgery. More specifically, the present disclosure relates to harvestingosteochondral plugs and creating recipient sockets for squareosteochondral plugs.

BACKGROUND

Osteochondral plugs can be used to treat cartilage defects in kneejoints, hip joints, and ankle joints. For example, a recipient socketcan be created in a bone to be treated and an osteochondral plug can beinserted in the recipient socket. The osteochondral plug can beharvested from a bone of a cadaver, e.g., a femur, a tibia, a fibula,etc. The osteochondral plug can be harvested by cutting the plug fromthe donor bone. To achieve the best results, the osteochondral plugshould closely fit into the recipient socket. Further, the curvature ofthe upper surface of the plug should closely match the curvature of thebone into which the plug is installed. Obtaining a close match betweenthe geometry of the plug and the geometry of the recipient socket andsurrounding tissue can be difficult.

Accordingly, there is a need for a system and method for harvestingosteochondral plugs and creating recipient sockets.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an osteochondral chisel assembly;

FIG. 2 is a plan view of an osteochondral chisel assembly;

FIG. 3 is a perspective view of an osteochondral chisel;

FIG. 4 is a first lateral plan view of the osteochondral chisel;

FIG. 5 is a second lateral plan view of the osteochondral chisel;

FIG. 6 is an end plan view of the osteochondral chisel;

FIG. 7 is a perspective view of an osteochondral chisel adapter;

FIG. 8 is a first lateral plan view of the osteochondral chisel adapter;

FIG. 9 is a second lateral plan view of the osteochondral chiseladapter;

FIG. 10 is a plan view of a first embodiment of a harvest guideassembly;

FIG. 11 is a perspective view of an impactor associated with the firstharvest guide assembly;

FIG. 12 is a first lateral plan view of the impactor;

FIG. 13 is a second lateral plan view of the impactor;

FIG. 14 is an end plan view of the impactor;

FIG. 15 is a perspective view of an orientation guide associated withthe first harvest guide assembly;

FIG. 16 is a top plan view of the orientation guide;

FIG. 17 is a first lateral plan view of the orientation guide;

FIG. 18 is a second lateral plan view of the orientation guide;

FIG. 19 is a perspective view of a harvest guide associated with thefirst harvest guide assembly;

FIG. 20 is a first lateral plan view of the harvest guide;

FIG. 21 is a second lateral plan view of the harvest guide;

FIG. 22 is a top plan view of the harvest guide;

FIG. 23 is a flow chart illustrating a first method of harvesting anosteochondral plug;

FIG. 24 is a photograph illustrating a first step of the method;

FIG. 25 is a photograph illustrating a second step of the method;

FIG. 26 is a photograph illustrating a third step of the method;

FIG. 27 is a photograph illustrating a fourth step of the method;

FIG. 28 is a photograph illustrating a fifth step of the method;

FIG. 29 is a photograph illustrating a sixth step of the method;

FIG. 30 is a photograph illustrating a seventh step of the method;

FIG. 31 is a photograph illustrating an eighth step of the method;

FIG. 32 is a photograph illustrating a ninth step of the method;

FIG. 33 is a photograph illustrating a tenth step of the method;

FIG. 34 is a photograph illustrating an eleventh step of the method;

FIG. 35 is a photograph illustrating a twelfth step of the method;

FIG. 36 is a photograph illustrating a condyle with a plurality ofosteochondral plugs formed therein;

FIG. 37 is a photograph illustrating a thirteenth step of the method;

FIG. 38 is a photograph illustrating an osteochondral plug;

FIG. 39 is a perspective view of a trephine;

FIG. 40 is a plan view of the trephine;

FIG. 41 is another plan view of the trephine;

FIG. 42 is a plan view of a second embodiment of a harvest guideassembly;

FIG. 43 is a perspective view of an orientation guide associated withthe second harvest guide assembly;

FIG. 44 is a top plan view of the orientation guide;

FIG. 45 is a first lateral plan view of the orientation guide;

FIG. 46 is a second lateral plan view of the orientation guide;

FIG. 47 is a perspective view of a harvest guide associated with thesecond harvest guide assembly;

FIG. 48 is a first lateral plan view of the harvest guide;

FIG. 49 is a second lateral plan view of the harvest guide;

FIG. 50 is a top plan view of the harvest guide; and

FIG. 51 is a flow chart illustrating a second embodiment of a method ofharvesting an osteochondral plug.

DETAILED DESCRIPTION OF THE DRAWINGS

An osteochondral chisel is disclosed and can include a body that canhave a proximal end and a distal end. A first portion can extend fromthe proximal end. Further, a second portion can extend from the distalend and can terminate at the first portion. The second portion can behollow and can include an internal cavity. The second portion can bedriven linearly into tissue in order to create a plug having a shapethat substantially matches the internal cavity of the second portion ofthe body.

In another embodiment, an osteochondral chisel adapter is disclosed andcan include a post that can have a proximal end and a distal end. Anenlarged head can extend from the distal end of the post. The enlargedhead can engage an internal cavity formed in an osteochondral chisel.

In yet another embodiment, an osteochondral chisel assembly is disclosedand can include an osteochondral chisel and an osteochondral chiseladapter. The osteochondral chisel adapter can engage the osteochondralchisel and a linear actuator device.

In still another embodiment, a harvest guide for a cutting device isdisclosed and can include a body having a top and a bottom. Further, theharvest guide can include an interior cavity formed within the body fromthe top to the bottom. The interior cavity can receive the cuttingdevice.

In yet still another embodiment, an orientation guide for a harvestguide is disclosed and can include a body that can have a top and abottom. A first foot can extend from the bottom of the body. A secondfoot can also extend from the bottom of the body. Further, a third footcan extend from the bottom of the body. The orientation guide can reston bony tissue. Moreover, the first foot, the second foot and the thirdfoot can be configured such that the orientation guide can be properlyoriented when all three of the first foot, the second foot and the thirdfoot are in simultaneous contact with the bony tissue.

In another embodiment, an impactor is disclosed and can include a shaftthat can have a proximal end and a distal end. A harvest guide cap canextend from the distal end of the shaft. The harvest guide cap can beconfigured to fit around a harvest guide that is configured to receive acutting device.

In still another embodiment, a harvest guide assembly is disclosed andcan include a harvest guide that can have an internal cavity. Also, theharvest guide can be driven into bony tissue. The harvest guide assemblycan also include an orientation guide that can fit into the internalcavity of the harvest guide. The orientation guide can be used to orientthe harvest guide relative to bony tissue.

In yet still another embodiment, a method is disclosed and can includeengaging a harvest guide with bony tissue and placing a cutting devicewithin the harvest guide. The harvest guide can maintain the cuttingdevice substantially perpendicular to a tangent through a point on thebony tissue aligned with the cutting device.

Description of an Osteochondral Chisel Assembly

Referring initially to FIG. 1 and FIG. 2, an osteochondral chiselassembly is shown and is generally designated 100. As illustrated, theosteochondral chisel assembly 100 can include an osteochondral chisel300 and an osteochondral chisel adapter 700. As described in greaterdetail below, the osteochondral chisel 300 can fit into theosteochondral adapter 700.

Description of the Osteochondral Chisel

FIG. 3 through FIG. 6 illustrate the details of the osteochondral chisel300. As shown the osteochondral chisel 300 can include a body 302. Thebody 302 can include a proximal end 304 and a distal end 306.Additionally, the body 302 can include a first portion 308 near theproximal end 304 of the body 302. Further, the body 302 can include asecond portion 310 that extends from the first portion 308 andterminates at the distal end 306.

In a particular embodiment, the first portion 308 of the body 302 can begenerally cylindrical. Further, the first portion 308 of the body 302can be formed with an internal cavity 312 that can extend into the firstportion 308 from the proximal end 304 of the body 302. As describedbelow, the osteochondral chisel adapter 700 can fit into the internalcavity 312 formed in the first portion 308 of the body 302.

As shown in FIG. 3, the second portion 310 of the body 302 can be hollowand generally prismatic. In particular, the second portion 310 can be aprism having a generally square cross-section. More specifically, thesecond portion 310 can be a parallelepiped having a generally squarecross-section. Further, as depicted in FIG. 3, the second portion 310 ofthe body 302 can include an internal cavity 314. Also, the secondportion 310 of the body 302 can include a cutting edge 316 formed at thedistal end 306 of the body 302. The osteochondral chisel 300 can bedriven into tissue, e.g., bone, to create an osteochondral plug.Further, the osteochondral chisel 300 can be driven into tissue, e.g.,bone, to create a recipient socket for an osteochondral plug.

Description of the Osteochondral Chisel Adapter

Referring to FIG. 7 through FIG. 9, the osteochondral chisel adapter 700is shown. The osteochondral chisel adapter 700 can include a post 702having a proximal end 704 and a distal end 706. The post 702 can begenerally cylindrical. Moreover, as shown in FIG. 7 through FIG. 9, thepost 702 can include an annular groove 708 formed near the proximal end704 of the post 702.

The osteochondral chisel adapter 700 can also include an enlarged head710 that can be coupled to the distal end 706 of the post 702. Theenlarged head 712 can be generally cylindrical. Further, the enlargedhead 712 can include an osteochondral chisel engagement portion 712. Ina particular embodiment, the osteochondral chisel engagement portion 712is sized and shaped to fit into the internal cavity 312 formed in thefirst portion 308 of the body 302 of the osteochondral chisel 300, shownin FIG. 3 through FIG. 6.

Description of a First Embodiment of a Harvest Guide Assembly

Referring to FIG. 10, a harvest guide assembly is shown and is generallydesignated 1000. As depicted in FIG. 10, the harvest guide assembly 1000can include an impactor 1100, an orientation guide 1500, and a harvestguide 1900.

Description of an Impactor Associated with the First Harvest GuideAssembly

Referring to FIG. 11 through FIG. 14, details concerning the impactor1100 can be seen. As illustrated, the impactor 1100 can include a shaft1102 that can have a proximal end 1104 and a distal end 1106. Further,an impact plate 1108 can be coupled, or otherwise connected, to theproximal end 1104 of the shaft 1102. FIG. 11 through FIG. 14 alsoindicate that a harvest guide cap 1110 can be coupled, or otherwiseconnected, to the distal end 1106 of the shaft 1102. The harvest guidecap 1110 can include an internal cavity 1112 that can be sized andshaped to fit around the harvest guide 1900 (FIG. 10), described indetail below. In a particular embodiment, the impact plate 1108 and theharvest guide cap 1110 can be integrally formed with the shaft 1102.

During use, the impactor 1100 can be placed around the harvest guide1900 (FIG. 10). Moreover, a hammer can be used to strike the impactplate 1108. The shaft 1102 can transmit the impact from the hammer tothe harvest guide cap 1110. Further, the harvest guide cap 1110 cantransmit the impact to the harvest guide 1900 (FIG. 10) and the harvestguide 1900 can be driven into a condyle.

Description of an Orientation Guide Associated with the First HarvestGuide Assembly

Referring to FIG. 15 through FIG. 18, details concerning the orientationguide 1500 can be seen. As depicted, the orientation guide 1500 caninclude a generally cubic body 1502. The body 1502 can include a topsurface 1504 and a bottom surface 1506. Further, a handle 1508 canextend from the top surface 1504 of the body 1502. The handle 1508 caninclude a first portion 1510 that can be generally perpendicular to thetop surface 1504 of the body 1502. Also, the handle 1508 can include asecond portion 1512 that can extend substantially perpendicular from thefirst portion 1510 of the handle 1508. The second portion 1512 of thehandle 1508 can also be substantially parallel to the top surface 1504of the body 1502.

FIG. 15 through FIG. 18 also show that the orientation guide 1500 caninclude a first foot 1514, a second foot 1516, and a third foot 1518extending from the bottom surface 1506 of the body 1502. In a particularembodiment, each foot 1514, 1516, 1518 can extend from the bottomsurface 1506 at an angle relative to the bottom surface 1506.Accordingly, in a particular embodiment, the orientation guide 1500 canbe an orientation tripod having three feet on which the orientationtripod can rest.

During use, the orientation guide 1500 can be fitted into the harvestguide 1900 (FIG. 10). Further, the orientation guide 1500 and harvestguide 1900 (FIG. 10) can be placed on a rounded surface of a condyle.The orientation guide 1500, e.g., each foot 1514, 1516, 1518 thereof,can ensure proper placement and alignment of the harvest guide 1900(FIG. 10) prior to the harvest guide 1900 (FIG. 10) being driven intothe condyle, as described herein. After the harvest guide 1900 (FIG. 10)is driven into the condyle, the orientation guide 1500 can be removedfrom the harvest guide 1900 (FIG. 10).

When the orientation guide 1500 is placed within the harvest guide 1900(FIG. 10), as described herein, the handle 1508 that extends from thebody 1502 of the orientation guide 1500 can extend through a slot formedin the harvest guide 1900 (FIG. 10). In particular, the second portion1512 of the handle 1508 can extend through the slot formed in theharvest guide 1900 (FIG. 10). The handle 1508 can facilitate placementof the orientation guide 1500 within the harvest guide 1900 (FIG. 10).Further, the handle 1508 can facilitate retrieval of the orientationguide 1500 from within the harvest guide 1900 (FIG. 10).

Description of a Harvest Guide Associated with the First Harvest GuideAssembly

Referring to FIG. 19 through FIG. 22, the details concerning the harvestguide 1900 can be seen. As shown, the harvest guide 1900 can include agenerally cylindrical body 1902. The body 1902 can include a top 1904and a bottom 1906. Further, the body 1902 can include a slot 1908 and aninterior cavity 1910 formed therein. The slot 1908 can extend from thetop 1904 of the body 1902 partially along the length of the body 1902.The interior cavity 1910 can be sized and shaped to receive theorientation guide 1500, i.e., the interior cavity can be generallycubic.

FIG. 19 through FIG. 22 further indicate that the harvest guide 1900 caninclude a first tissue engagement post 1912, a second tissue engagementpost 1914, and a third tissue engagement post 1916. The tissueengagement posts 1912, 1914, 1916 can extend from the bottom 1906 of thebody 1902. Further, the tissue engagement posts 1912, 1914, 1916 canextend substantially perpendicularly from the bottom 1906 of the body1902.

As described herein, the orientation guide 1500 (FIG. 15 through FIG.18) can fit into the internal cavity 1910 formed in the body 1902 of theharvest guide 1900. Further, the handle 1508 (FIG. 15 through FIG. 18)that extends from the body 1502 (FIG. 15 through FIG. 18) of theorientation guide 1500 (FIG. 15 through FIG. 18) can extend through theslot 1908 formed in the body 1902 of the harvest guide 1900.Additionally, after the harvest guide 1900 is driven into a condyle, asdescribed herein, the tissue engagement posts 1912, 1914, 1916 canengage the condyle and prevent the harvest guide 1900 from movingrelative to the condyle. Further, after the orientation guide 1500 (FIG.15 through FIG. 18) is retrieved from within the harvest guide 1900, asdescribed herein, the osteochondral chisel 300 (FIG. 3 through FIG. 6)can be placed within the harvest guide 1900 and driven into the condyleusing a linear actuator device, e.g., a pneumatic linearly activateddevice. The osteochondral chisel 300 (FIG. 3 through FIG. 6) can be usedto harvest an osteochondral plug and to create a recipient socket for anosteochondral plug.

Description of a First Embodiment of a Method of HarvestingOsteochondral Plugs

FIG. 23 illustrates a flow chart of a first embodiment of a method ofharvesting osteochondral plugs from bony tissue, e.g., from a condyle ofa femur. FIG. 24 through FIG. 38 are a series of photographs chroniclingan exemplary, non-limiting execution of the method of harvestingosteochondral plugs. For clarity, the method depicted in FIG. 23 will bedescribed with continued reference to FIG. 23 and periodic reference tothe photos shown in FIG. 24 through FIG. 38. In a particular embodiment,the osteochondral plugs can be harvested using an osteochondral chiselassembly and a harvest guide assembly according to one or more of theembodiments described herein. The osteochondral chisel assembly caninclude an osteochondral chisel and an osteochondral chisel adapter,described herein. Further, the harvest guide assembly can include animpactor, an orientation guide, and a harvest guide, described herein.

Commencing at block 2300 in FIG. 23, a depth on a femur can be measured.For example, as shown in FIG. 24, the depth on the femur can be measuredusing a stainless ruler and marked using a pencil. At block 2302 of FIG.23, the femur can be cut to depth. As shown in FIG. 25, the femur can becut to depth using a band saw. Alternatively, the femur can be cut todepth using a reciprocating saw or some other sharp bladed implement.Moving to block 2304 of FIG. 23, a condyle cut from the femur can beclamped within a vise, as depicted in FIG. 26.

At block 2306, the orientation guide can be placed within the harvestguide, as shown in FIG. 27. Moreover, at block 2308 of FIG. 23, theharvest guide and orientation guide assembly can be placed on thecondyle, as shown in FIG. 28. At block 2310 of FIG. 23, the impactor canbe placed over the harvest guide, as depicted in FIG. 29. Further, atblock 2312 of FIG. 23, the impactor can be tapped with a hammer, asshown in FIG. 30, in order to drive the harvest guide into the condyle.

Continuing to block 2314 of FIG. 23, a user, e.g., a surgeon, can verifythat all of the feet extending from the orientation guide are touchingthe surface of the condyle, as depicted in FIG. 31. If one or more ofthe feet is not touching the surface of the condyle, the harvest guidecan be removed and re-engaged with the surface of the condyle, asdescribed above. On the other hand, if each of the feet is touching thesurface of the condyle, the method can continue to block 2316 of FIG. 23and the orientation guide can be removed from the harvest guide, asshown in FIG. 32.

At block 2318 of FIG. 23, and as shown in FIG. 33, the osteochondralchisel can be inserted into the harvest guide. The harvest guide, whenproperly placed, can maintain the osteochondral chisel substantiallyperpendicular to a tangent through a point on the bony tissue alignedwith the osteochondral chisel. Particularly, the harvest guide canmaintain the osteochondral chisel substantially perpendicular to atangent through a point on the bony tissue that is aligned with alongitudinal axis of the osteochondral chisel. Thereafter, at block2320, the osteochondral chisel can be driven through the harvest guideinto the condyle, as depicted in FIG. 34. In a particular embodiment,the osteochondral chisel can be driven into the harvest guide until thechisel impacts the harvest guide. Further, in a particular embodiment,the osteochondral chisel can be driven into the harvest guide using apneumatic linear actuator device. The osteochondral chisel can cut aperimeter surface of the osteochondral plug.

Continuing to block 2322 of FIG. 23, the osteochondral chisel andharvest guide can be removed from the condyle, as shown in FIG. 35. FIG.36 depicts the condyle with the osteochondral chisel and harvest guideremoved therefrom. Moreover, at block 2324 of FIG. 23, one or moreosteochondral plugs can be removed from the condyle. In a particularembodiment, as shown in FIG. 37, the osteochondral plugs can be removedfrom the condyle using a band saw. Alternatively, the osteochondralplugs can be removed using another type of saw or sharp, bladedimplement. FIG. 38 depicts a single osteochondral plug that can beharvested using the method described herein. At block 2326 of FIG. 23,one or more osteochondral plugs can be packaged for delivery to a user,e.g., a surgeon. The method can end at state 2328.

The osteochondral chisel assembly and the harvest guide assembly canalso be used to create a recipient socket. The method to create arecipient socket can be similar to the method for harvesting anosteochondral plug. For example, the harvest guide can be affixed to therecipient bone in a similar fashion. Moreover, the osteochondral chiselcan be driven through the harvest guide and into the recipient bonesimilar to the manner described herein. Using similar methods allows thegeometry of the osteochondral plug to closely match the geometry of therecipient socket and surrounding tissue in which the recipient socket iscreated.

Description of a Trephine

Referring to FIG. 39 through FIG. 41, an embodiment of a trephine isshown and is generally designated 3900. As shown, the trephine 3900 caninclude a shaft 3902 having a proximal end 3904 and a distal end 3904.In a particular embodiment, the proximal end 3904 of the shaft 302 canbe configured to be received within a drill chuck, e.g., a drill chuckof a surgical drill.

As indicated in FIG. 39 through FIG. 41, the trephine 3900 can include ahollow cutting head 3908 that can extend from the distal end 3904 of theshaft 3902. The cutting head 3908 of the trephine 3900 can include aproximal end 3910 and a distal end 3912. As shown, the proximal end 3910of the cutting head 3908 can be attached to the distal end 3906 of theshaft 3902.

FIG. 39 through FIG. 41 further indicate that the distal end 3912 of thecutting head 3908 can be formed with a plurality of cutting teeth 3914.As the trephine 3900 is rotated, e.g., by a surgical drill, the cuttingteeth 3914 can cut into tissue, e.g., bone. As further illustrated inFIG. 39 through FIG. 41, the cutting head 3908 of the trephine 3900 caninclude a plurality of depth indicators 3916. When used in conjunctionwith a harvest guide, described below, the depth indicators 3916 canindicate a penetration depth of the cutting head 3908. The depthindicators 3916 can be laser etched, or otherwise formed, atpredetermined locations along the cutting head 3908 of the trephine 3900between the distal end 3912 of the cutting head 3908 and the proximalend 3910 of the cutting head 3908.

Further, the cutting head 3908 can include a depth stop 3918 that cancircumscribe the cutting head 3908. When the trephine 3900 is used inconjunction with a harvest guide, described below, the depth stop 3918can prevent the cutting head 3908 of the trephine 3900 from moving toofar through the harvest guide and penetrating too deeply into a patient.

Description of a Second Embodiment of a Harvest Guide Assembly

Referring to FIG. 42, a second embodiment of a harvest guide assembly isshown and is generally designated 4200. As depicted in FIG. 42, theharvest guide assembly 4200 can include an impactor 4250, an orientationguide 4300, and a harvest guide 4700.

Description of an Impactor Associated with the Second Harvest GuideAssembly

In a particular embodiment, the impactor 4250 can be configured similarto the impactor described above in conjunction with FIG. 11 through FIG.14. During use, the impactor 4250 can be placed around the harvest guide4700. Moreover, a hammer can be used to strike the impactor 4250. Theimpactor 4250 can transmit the impact from the hammer to the harvestguide 4700 and the harvest guide 4700 can be driven into a condyle.

Description of an Orientation Guide Associated with the Second HarvestGuide Assembly

Referring to FIG. 43 through FIG. 46, details concerning the orientationguide 4300 associated with the second harvest guide assembly 4200 (FIG.42) can be seen. As depicted, the orientation guide 4300 can include agenerally cylindrical body 4302. The body 4302 can include a top surface4304 and a bottom surface 4306. A first post 4308 can extendsubstantially perpendicular from the top surface 4304 of the body 4302.Moreover, a second post 4310 can extend radially outward from the body4302. The second post 4310 can be substantially perpendicular to thefirst post 4308.

FIG. 43, FIG. 45, and FIG. 46 further indicate that the orientationguide 4300 can include a first foot 4314, a second foot 4316, and athird foot 4318 extending from the bottom surface 4306 of the body 4302.In a particular embodiment, each foot 4314, 4316, 4318 can extend fromthe bottom surface 4306 at an angle relative to the bottom surface 4306.Accordingly, in a particular embodiment, the orientation guide 4300 canbe an orientation tripod having three feet on which the orientationtripod can rest.

During use, the orientation guide 4300 can be fitted into the harvestguide 4700 (FIG. 42). Further, the orientation guide 4300 and harvestguide 4700 (FIG. 42) can be placed on a rounded surface of a condyle.The orientation guide 4300, e.g., each foot 4314, 4316, 4318 thereof,can ensure proper placement and alignment of the harvest guide 4700(FIG. 42) prior to the harvest guide 4700 (FIG. 42) being driven intothe condyle, as described herein. After the harvest guide 4700 (FIG. 42)is driven into the condyle, the orientation guide 4300 can be removedfrom the harvest guide 4700 (FIG. 42).

When the orientation guide 4300 is placed within the harvest guide 4700(FIG. 42), as described herein, the second post 4310 that extends fromthe body 4302 of the orientation guide 4300 can extend through a slotformed in the harvest guide 4700 (FIG. 42). The second post 4310 canfacilitate placement and alignment of the orientation guide 4300 withinthe harvest guide 4700 (FIG. 42). Further, the first post 4308 canfacilitate retrieval of the orientation guide 4300 from within theharvest guide 4700 (FIG. 42).

Description of a Harvest Guide Associated with the Second Harvest GuideAssembly

Referring to FIG. 47 through FIG. 50, the details concerning the harvestguide 4700 associated with the second harvest guide assembly 4200 (FIG.42) can be seen. As shown, the harvest guide 4700 can include agenerally cylindrical body 4702. The body 4702 can include a top 4704and a bottom 4706. Further, the body 4702 can include a slot 4708 and aninterior cavity 4710 formed therein. The slot 4708 can extend from thetop 4704 of the body 4702 partially along the length of the body 4702.The interior cavity 4710 can be sized and shaped to receive theorientation guide 1500, i.e., the interior cavity 4710 can be generallycylindrical.

FIG. 47 through FIG. 50 further indicate that the harvest guide 4700 caninclude a first tissue engagement post 4712, a second tissue engagementpost 4714, and a third tissue engagement post 4716. The tissueengagement posts 4712, 4714, 4716 can extend from the bottom 4706 of thebody 4702. Further, the tissue engagement posts 4712, 4714, 4716 canextend substantially perpendicularly from the bottom 4706 of the body4702.

As described herein, the orientation guide 4300 (FIG. 43 through FIG.46) can fit into the internal cavity 4710 formed in the body 4702 of theharvest guide 4700. Further, the second post 4310 (FIG. 43 through FIG.45) that extends from the body 4302 (FIG. 43 through FIG. 45) of theorientation guide 4300 (FIG. 43 through FIG. 45) can extend through theslot 4708 formed in the body 4702 of the harvest guide 4700.Additionally, after the harvest guide 4700 is driven into a condyle, asdescribed herein, the tissue engagement posts 4712, 4714, 4716 canengage the condyle and prevent the harvest guide 4700 from movingrelative to the condyle. Further, after the orientation guide 4300 (FIG.43 through FIG. 46) is retrieved from within the harvest guide 4700, asdescribed herein, the trephine 3900 (FIG. 39 through FIG. 41) can beplaced within the harvest guide 4700 and rotated into the condyle usinga rotary device, e.g., a surgical drill. The trephine 3900 (FIG. 39through FIG. 41) can be used to harvest an osteochondral plug and tocreate a recipient socket for an osteochondral plug.

Description of a Second Method of Harvesting Osteochondral Plugs

FIG. 51 illustrates a flow chart of a second method of harvestingosteochondral plugs from bony tissue, e.g., from a condyle of a femur.In a particular embodiment, the osteochondral plugs can be harvestedusing a trephine and a harvest guide assembly according to one or moreof the embodiments described herein. The harvest guide assembly caninclude an impactor, an orientation guide, and a harvest guide,described herein.

Commencing at block 5100 in FIG. 51, the orientation guide can be placedwithin the harvest guide. Moreover, at block 5102, the harvest guide andorientation guide assembly can be placed on a condyle. At block 5104,the impactor can be placed over the harvest guide. Further, at block5106, the impactor can be tapped with a hammer in order to drive theharvest guide into the condyle.

Continuing to block 5108, a user, e.g., a surgeon, can verify that allof the feet extending from the orientation guide are touching thesurface of the condyle. If one or more of the feet is not touching thesurface of the condyle, the harvest guide can be removed and re-engagedwith the surface of the condyle, as described above. On the other hand,if each of the feet is touching the surface of the condyle, the methodcan continue to block 5110 of FIG. 51 and the orientation guide can beremoved from the harvest guide.

At block 5112 of FIG. 51, the tip of the trephine can be inserted intothe harvest guide. The harvest guide, when properly placed, can maintainthe osteochondral chisel substantially perpendicular to a tangentthrough a point on the bony tissue aligned with the osteochondralchisel. Particularly, the harvest guide can maintain the osteochondralchisel substantially perpendicular to a tangent through a point on thebony tissue that is aligned with a longitudinal axis of theosteochondral chisel. Thereafter, at block 5114, the trephine can berotated and moved through the harvest guide into the condyle until apredetermined depth is reached. In a particular embodiment, the trephinecan be moved through the harvest guide until the stop on the trephineimpacts the harvest guide. Alternatively, the trephine can be movedthrough the harvest guide until a particular depth indicator issubstantially aligned with an upper surface of the harvest guide.Further, in a particular embodiment, the trephine can be moved throughthe harvest guide using a surgical drill. The trephine can cut aperimeter surface of the osteochondral plug.

Continuing to block 5116, the trephine and harvest guide can be removedfrom the condyle. Moreover, at block 5118, one or more osteochondralplugs can be removed from the condyle. At block 5120, the one or moreosteochondral plugs can be trimmed in order to get a squarecross-section, if necessary. Moving to block 5122, one or moreosteochondral plugs can be packaged for delivery to a user, e.g., asurgeon. The method can end at state 5124.

The trephine and the harvest guide assembly can also be used to create arecipient socket. The method to create a recipient socket can be similarto the method for harvesting an osteochondral plug. For example, theharvest guide can be affixed to the recipient bone in a similar fashion.Moreover, the trephine can be moved through the harvest guide and intothe recipient bone similar to the manner described herein. Using similarmethods allows the geometry of the osteochondral plug to closely matchthe geometry of the recipient socket and surrounding tissue in which therecipient socket is created.

CONCLUSION

With the configuration of structure described above, the system forharvesting osteochondral plugs provides one or more devices that canfacilitate the harvesting of osteochondral plugs from one or morecondyles. Further, the system can be used to create recipient sockets ina condyle, or other bone, for receiving an osteochondral plug. A harvestguide of the system can maintain a cutting device, e.g., anosteochondral chisel, a trephine, or a combination thereof,substantially perpendicular to a tangent through a point on the condylethat is aligned with the cutting device. As such, the osteochondral plugcan have a surface with a curvature that is substantially uniform fromside to side. Further, the harvest guide can act as a stop for thecontrolling the length of insertion of the osteochondral chisel, ortrephine, into the condyle. Accordingly, the harvest guide can controlthe length of the harvested osteochondral plug.

The above-disclosed subject matter is to be considered illustrative, andnot restrictive, and the appended claims are intended to cover all suchmodifications, enhancements, and other embodiments that fall within thetrue spirit and scope of the present invention. Thus, to the maximumextent allowed by law, the scope of the present invention is to bedetermined by the broadest permissible interpretation of the followingclaims and their equivalents, and shall not be restricted or limited bythe foregoing detailed description.

1. An impactor assembly for harvesting osteochondral plugs, comprising:a shaft having a proximal end and a distal end; a harvest guide capextending from the distal end of the shaft; and a harvest guideconfigured to fit within the harvest guide cap, the harvest guide havingan axis, a top, a sidewall with a slot extending from the top and abottom, an interior cavity having a cross-section that is generallysquare or generally round, the inner cavity configured to receive eitheran orientation guide or a cutting device for orienting and harvestingosteochondral plugs; and a plurality of tissue engagement posts equal inaxial length, extending substantially perpendicularly from the bottom ofthe harvest guide and configured to be driven into a bony tissue of acondyle and prevent the harvest guide from moving relative to the bonytissue of the condyle; the orientation guide further comprising: a bodyhaving an axis, a top, a sidewall perimeter and a bottom; a first footextending from the bottom of the body; a second foot extending from thebottom of the body; a third foot extending from the bottom of the bodyand the first, second and third feet are equal in axial length, whereinthe orientation guide is configured to rest on bony tissue and whereinthe first foot, the second foot and the third foot are configured suchthat the orientation guide is properly oriented when all three of thefirst foot, the second foot and the third foot are in simultaneouscontact with the bony tissue; a handle extending from the body, whereinthe handle includes a portion that extends laterally beyond the sidewallperimeter and is substantially perpendicular to the axis to facilitateplacement of the orientation guide within a sidewall slot of the harvestguide and facilitate retrieval of the orientation guide from within theharvest guide; wherein the orientation guide is configured to fit withinthe harvest guide and orient the harvest guide relative to bony tissue.2. The harvest guide of claim 1, wherein the cutting device comprises anosteochondral chisel, a trephine, or a combination thereof.
 3. Theassembly of claim 1, wherein the impactor further comprises an internalcavity formed in the harvest guide cap, wherein the internal cavity issized and shaped to fit over the harvest guide.
 4. The assembly of claim3, wherein the impactor further comprises an impact plate extending fromthe proximal end of the shaft.
 5. A method for harvesting osteochondralplugs, comprising: placing an orientation guide within a harvest guide;engaging the harvest guide with bony tissue, wherein the harvest guidecomprises a body having a top and a bottom, an interior cavity formedwithin the body from the top to the bottom configured to receive eitherthe orientation guide for orienting the harvest guide on the bony tissuewithout penetrating the bony tissue with the orientation guide, or acutting device, and at least one tissue engagement post extendingsubstantially perpendicularly from the bottom of the body to maintainthe cutting device substantially perpendicular to a tangent through apoint on the bony tissue aligned with the cutting device, wherein thetissue engagement post of the harvest guide is configured to be driveninto the bony tissue and prevent the harvest guide from moving relativeto the bony tissue; removing the orientation guide from the harvestguide; and placing the cutting device within the harvest guide, whereinthe cutting device is configured to harvest osteochondral plugs; theorientation guide further comprising: a body having an axis, a top, asidewall perimeter and a bottom; a first foot extending from the bottomof the body; a second foot extending from the bottom of the body; athird foot extending from the bottom of the body and the first, secondand third feet are equal in axial length, wherein the orientation guideis configured to rest on bony tissue and wherein the first foot, thesecond foot and the third foot are configured such that the orientationguide is properly oriented when all three of the first foot, the secondfoot and the third foot are in simultaneous contact with the bonytissue; a handle extending from the body, wherein the handle includes aportion that extends laterally beyond the sidewall perimeter and issubstantially perpendicular to the axis to facilitate placement of theorientation guide within a sidewall slot of the harvest guide andfacilitate retrieval of the orientation guide from within the harvestguide; wherein the orientation guide is configured to fit within theharvest guide and orient the harvest guide relative to bony tissue. 6.The method of claim 5, further comprising moving the cutting devicethrough the harvest guide into the bony tissue to cut a perimetersurface of the osteochondral plug.
 7. The method of claim 6, furthercomprising removing the cutting device from the bony tissue and theharvest guide.
 8. The method of claim 7, further comprising removing theharvest guide from the bony tissue.
 9. The method of claim 8, furthercomprising removing the osteochondral plug from the bony tissue.
 10. Themethod of claim 5, further comprising placing the harvest guide andorientation guide on the bony tissue.
 11. The method of claim 10,wherein the orientation guide has a first foot, a second foot, and athird foot extending therefrom, the method further comprising verifyingthat each foot is touching a surface of the bony tissue.
 12. The methodof claim 11, further comprising placing an impactor over the harvestguide.
 13. The method of claim 12, further comprising tapping theimpactor with a hammer in order to drive the harvest guide into the bonytissue.
 14. The method of claim 5, wherein the cutting device comprisesan osteochondral chisel, a trephine, or a combination thereof.